REPORT FORM
| BUREAU OF SPECIAL RELIEF | HERBERT GUNN, M. D. | ||||||||
| Supt. Bureau Special Relief | |||||||||
| Department of Relief and Rehabilitation San Francisco Relief and Red Cross Funds GEARY AND GOUGH STREETS | |||||||||
| Week Ending | 190 | ||||||||
| REPORT OF SECTION | |||||||||
| NO. ORDERS ISSUED | NEW | ||||||||
| NO. ORDERS ISSUED | REPEAT | TOTAL | |||||||
| NO. ORDERS DISCONTINUED | |||||||||
| Are orders filled promptly and are articles of good quality? | |||||||||
| (SIGNED) | |||||||||
Above form as [illustration]
MEDICAL SERVICE FORM[306]
| Nº 1102 | HERBERT GUNN, M. D. Supt. Bureau Special Relief | |||||||||||
| BUREAU OF SPECIAL RELIEF | ||||||||||||
| Geary and Gough Streets | ||||||||||||
| San Francisco, | 1906 | |||||||||||
| Section | ||||||||||||
| Please call on | ||||||||||||
| Address | ||||||||||||
| Relief required | ||||||||||||
| Remarks | ||||||||||||
| Kindly return this paper with your report. | ||||||||||||
| Reported by letter or in person | ||||||||||||
| Refer to | ||||||||||||
Above form as [illustration]
[306] Printed with duplicate on yellow paper beneath for carbon copy.
ORDER FORM—A[307]
| Date | ||||||||||
| ORIGINAL REPEAT | BUREAU OF SPECIAL RELIEF | ORIGINAL ORDER | ||||||||
| No. | Date | |||||||||
| Surname | ||||||||||
| First Name: | Man’s | Woman’s | ||||||||
| Address | ||||||||||
| Address April 18, 1906? | ||||||||||
| Number in family? | Ages | |||||||||
| Adult Males? | Ages | |||||||||
| Adult Females? | Ages | |||||||||
| Name | Occupation | Where Employed | Amount per Week | |||||
| Amt. Recd. from Rehab. Com. $ | Date | |||||||||||
| How expended? | ||||||||||||
| Insurance? | Companies? | |||||||||||
| Savings Amount? | Bank: | |||||||||||
| Real Estate: | Value: | |||||||||||
| Location: | ||||||||||||
| Other resources: | ||||||||||||
| Residence Continuous in S. F. since April 18th? | ||||||||||||
| Will require relief for: | ||||||||||||
| Reason for requiring relief: | ||||||||||||
| Physician attending? | Paid? | ||||||||
| Articles required: | |||||||||
| Meat Order | |||||||||
| Approved | |||||||||
Above form as [illustration]
[307] Printed with duplicates on yellow paper for carbon copies.